NT⁃proBNP、红细胞分布宽度对老年急性心肌梗死后心力衰竭患者预后的评估价值分析

Value of NT⁃proBNP and red blood cell distribution width in evaluating the prognosis of elderly patients with heart failure following acute myocardial infarction

目的:探讨血N末端B型利钠肽原(NT⁃proBNP)、红细胞分布宽度(RDW)对老年急性心肌梗死后心力衰竭患者预后的评估价值。方法:选取97例老年急性心肌梗死后心力衰竭患者作为观察组。根据Killip分级不同将观察组患者分为Ⅱ级(Ⅱ级组,33例)、Ⅲ级(Ⅲ级组,41例)、Ⅳ级(Ⅳ级组,23例)。另外选取同时期来我院治疗的40例急性心肌梗死未合并心衰患者作为对照组。随访3年后,根据患者的预后是否良好分为预后良好组和预后不良组。采用时间分辨法检测血NT⁃proBNP水平,采用全自动血细胞检测仪检测RDW水平,采用受试者工作特性曲线(ROC)评估血NT⁃proBNP、RDW对老年急性心肌梗死后心力衰竭患者预后的诊断价值;采用Logistic回归分析探讨影响老年急性心肌梗死后心力衰竭患者预后的危险因素。结果:观察组患者血NT⁃proBNP、RDW水平明显高于对照组(P<0.05)。Ⅱ级组患者的NT⁃proBNP、RDW水平明显低于Ⅲ级组、Ⅳ级组,Ⅲ级组患者的NT⁃proBNP、RDW水平低于Ⅳ级组(P<0.05)。预后良好组的血NT⁃proBNP、RDW水平明显低于预后不良组(P<0.05)。ROC曲线分析结果显示,两者联合预测的AUC为0.914,特异度为89.39%,敏感度为87.09%。多因素Logistic回归分析结果显示,NT⁃proBNP、LVEF、RDW是影响老年急性心肌梗死后心力衰竭患者预后的危险因素(P<0.05)。结论:血NT⁃proBNP、RDW在老年急性心肌梗死后心力衰竭患者中水平升高,并且与患者疾病严重程度有关,能够作为评估患者预后的生物学指标,有临床推广的价值。

Objective:To investigate the value of plasma N⁃terminal pro⁃B⁃type natriuretic peptide(NT⁃proBNP)and red blood cell distribution width(RDW)in prognosis evaluation for elderly patients with heart failure following acute myocardial infarction.Methods:Ninety⁃seven elderly patients with heart failure following acute myocardial infarction were included as the study group.According to Killip severity,all patients in the study group were divided into classⅡgroup(n=33),classⅢgroup(n=41),and classⅣgroup(n=23),respectively.A contemporary cohort of 40 patients without heart failure after acute myocardial infarction admitted to our hospital was included as the control group.After 3 years of follow⁃up,the patients were divided into good prognosis group and poor prognosis group according to the prognosis.The plasma NT⁃proBNP level was examined by time⁃resolved immunoassay,and the RDW level was determined by automatic blood cell analyzer.Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of NT⁃proBNP and RDW in prognostication of elderly patients with heart failure following acute myocardial infarction.Logistic regression analysis was used to determine the risk factors affecting the prognosis of elderly patients with heart failure following acute myocardial infarction.Results:The plasma NT⁃proBNP and RDW levels in the study group were significantly higher than those in the control group(both P<0.05).The plasma NT⁃proBNP and RDW levels in classⅡgroup were significantly lower than those in classⅢgroup and classⅣgroup,and the plasma NT⁃proBNP and RDW levels in classⅢgroup were lower than those in classⅣgroup(all P<0.05).The plasma NT⁃proBNP and RDW levels in the good prognosis group were significantly lower than those in the poor prognosis group(both P<0.05).ROC curve showed that the area under cure(AUC)of the combined prediction was 0.914,the specificity was 89.39%,and the sensitivity was 87.09%,respectively.Multivariate logistic regression analysis showed that NT⁃proBNP,LVEF and RDW were risk factors affecting the prognosis of elderly patients with heart failure following acute myocardial infarction(all P<0.05).Conclusion:Plasma NT⁃proBNP and RDW levels are elevated in elderly patients with heart failure following acute myocardial infarction,and related to the severity of disease.They may be used as biological indicators to evaluate the prognosis of patients,and warrants widespread use in clinical settings.